It’s a common belief among the general public that every bunion will ultimately require surgery. And unfortunately, many bunions do eventually reach that point, especially if they are not well cared for during their earlier stages.
But here’s the truth: surgery is not an inevitable consequence of developing a bunion. Many people don’t need it yet. With proper management, some people may never need it.
There’s another side to this coin, however. While we’d always recommend that you pursue conservative care whenever possible, if you do need surgery, you really shouldn’t wait very long to get it. Your bunion will continue to worsen, putting you through unnecessary pain. Ultimately, you may even end up requiring a much more significant surgical procedure.
So, being able to tell when you’ve crossed over the line into needing surgery is an important skill to develop! The exact position of that line may be slightly different depending on the individual, but there are some basic guidelines that we recommend.
The Role of Non-Surgical Bunion Care
It’s important to understand that bunions are a progressive condition—meaning that they really don’t get better with time, and tend to get worse. In other words, once your bunion bump is there, it’s there unless and until you remove or realign it surgically.
That said, when you take action early enough, non-surgical remedies are often extremely effective at:
- Alleviating your present symptoms
- Preventing the development of future symptoms
- Slowing (or even halting) the rate at which your bunions get worse
We strongly recommend that you fully exhaust all non-surgical avenues to prevent and alleviate your bunion pain before the thought of surgery even enters your mind. While they won’t make the bump go away, the goal is to mitigate the effects so you can live your life to the fullest.
Some of the most common conservative remedies may include:
- Wearing broader, roomier shoes with enough space to accommodate the bunion and wiggling toes.
- Wearing custom orthotics to further cushion and support the feet (and keep pressure away from the unstable bunion joint).
- Using nonmedicated bunion pads to protect and cushion the bunion against pressure and friction from the inside of your shoe.
- Splinting the misaligned toe.
- Pain management strategies such as icing, using over-the-counter NSAIDs, a cortisone injection, or laser therapy.
Finding the Line
So how do you know when you’ve reached the point where surgery should be considered? As we said, these recommendations are made on a case-by-case basis, but in general we would recommend surgery if your case fits the following descriptions:
- You’ve given conservative treatments a solid try for at least a few months, and they aren’t working. In some cases, we might skip this step if you don’t see us until your bunion is very severe (as in, the big toe is crossing over the second one). But for the most part, we will strongly urge you to fully exhaust your nonsurgical remedies. We do not recommend you get bunion surgery purely for cosmetic reasons, if conservative treatments can provide relief.
- You are experiencing daily pain, OR your pain is keeping you from activities that are especially important to you. Here is where that “case by case” component comes in. Perhaps your bunion isn’t bothering you during your normal daily activities, but is making a favorite activity like hiking or rock climbing impossible. Some people may be fine with simply switching to a different, less painful hobby. For others, the very thought may seem inconceivable!
Ultimately, it’s really about your quality of life. If your bunions are preventing you from truly living and enjoying your life to the fullest, and you’ve run out of conservative remedies to try, then it’s time to take the next step.
Exploring Surgical Options
Another important point we need to make here: even though surgery is generally thought of as a “last resort,” that does not mean you should be afraid of taking that next step.
On the contrary, surgery can represent a much more complete and longer-lasting solution—and one that will allow you to fully return to the activities you used to love.
Potential surgical approaches include:
- Osteotomy – Cuts and realigns the joint; often combined with tendon or ligament repair to help hold the bones in the proper position
- Arthrodesis – removes parts of the joint surface that are damaged; uses screws, plates, wires to hold bones in place as they heal
- Resection arthroplasty – often used in arthritic patients; removes damaged part of joint, allowing scar tissue to form a flexible joint.
- Exostectomy – removes the part of the bone that protrudes; does not correct the basic cause of the deformity; only used if the toe has not drifted
Once we examine your bunion and the extent of your deformity, we will discuss with you the type of surgery we believe will bring the best result—based on factors such as your age, health status, and lifestyle goals. We’ll also explain what you will need to do before the operation, the anesthesia likely to be used, and what you can expect during recovery.
Managing Your Expectations
Bunion surgery typically will restore the shape of your foot to a more “normal” appearance in addition to alleviating your symptoms. While recurrence of the bunion later in life is possible, surgery is meant to be a long-term (and ideally permanent) solution.
However, it’s important to remember that the main goals of surgery, first and foremost, are to:
- Relieve pain
- Allow you to walk and engage in your favorite activities normally again
What this means is that, even after surgery, you may still need to wear orthotics regularly, wear wider shoes, avoid high heels, etc. in order to keep the pain away and prevent a recurrence of your symptoms.
We will, of course, make sure you are prepared with all the information you need about the chosen procedure, expected outcomes, and recovery timetables to make an informed decision about your bunion care.